Articles Posted in Senior Health Care

People are fortunately now not obligated to cover care received that was not part of the network if the care was given without that person’s consent. This is the result of a healthcare law that became effective at the beginning of 2020 and could lead to fewer insurance payment issues for many people.

The law’s safeguards from expensive medical bills, however, are only as valuable as a person’s awareness, understanding, and capacity to ensure enforcement of the protections occurs.

Surprise Bills Are Common

In 2020, President Biden and his administration as well as states throughout the country recently celebrated unprecedented gains in enrollment for the Affordable Care Act. Meanwhile, state-operated exchanges are striving to create alternative plans addressing outreach in the event that Congress fails to extend the Act beyond 2022. A substantial motivator for these enrollment gains in the Affordable Care Act.

The Role of State-Run Exchanges

Exchanges operated by the state are focused on plans for outreach and marketing in the event that Congress does not increase beyond 2022 a driver for enrollment gains. Some legislatures and healthcare experts have already warned that individuals could discover they are dropped off coverages and consumers might even end up in less advantageous plans addressing healthcare provided Congress fails to act within the corresponding window of time. 

The Governor of New York recently removed a three-month prohibition on a new regulation requiring nursing homes to satisfy minimum staffing requirements to provide patient care. Supporters of the regulation, which establishes minimum staffing ratios and requires that nursing home residents receive at least 3.5 hours a day of direct nursing care, have expressed satisfaction that the delay has ended.

Staffing Levels Are at a Difficult Low

One member of the 1199 SEIU union as well as a nurse at a Dunkirk nursing home has commented that over the last couple of years, times have occurred when she has been the only registered nurse on staff for several dozen residents. This nurse has commented that it is “heartbreaking” to even satisfy the basic need requirements of residents, which include things like personal hygiene. 

With more people approaching the age of 65, a growing number of people are considering the potential benefits available from Medicare as well as other insurance options. Medicare A plays the critical role of paying for hospital stays as well as other services like skilled nursing facilities and hospice care. Meanwhile, Part B  assists with physician visits and outpatient care. 

If you’re close to enrolling in Medicare, you should consider what Medicare covers. By learning what Medicare covers now as well as what it doesn’t, you can begin thinking of alternate strategies to make sure that you receive all of the appropriate care that you need. 

Prescriptions

On February 11, 2022, the appellate court for the 11th circuit reversed a decision by a lower court. The appellate court in Dobson v. Secretary of Health and Human Services held that Medicare must provide coverage for a beneficiary’s off-label use of a medication. 

How the Case Arose

The case concerns a Florida man who communicated with the Center for Medicare Advocacy because the man’s Part D Medicare coverage declined dronabinol coverage. Dronabinol is a man-made type of cannabis that is known under the trade names of Marinol, Reduvo, and Syndros. The medication is used to stimulate appetite as well as to treat nausea and sleep apnea. The medication is approved by the FDA for the treatment of HIV/AIDS-related anorexia and nausea and vomiting caused by chemotherapy. 

The substantial growth of elderly adults in the United States leads to more emergency room visits and complications from injuries and diseases. To meet this challenge, the Geriatric Emergency Department Guidelines were published in 2014 and later received support from several large medical organizations including Emergency Nurses Association and the American Geriatrics Society. 

The guidelines characterize the nuanced needs of older emergency department patients and current best practices to promote more cost-effective and patient-focused care. These recommendations require more staff as well as more resources. 

What Researchers Discovered

It’s almost an understatement to say that the Covid-19 pandemic has changed our lives and how we live in a range of ways. While Medicare did not pay for Covid-19 tests that were available over the counter, the Center for Medicaid Services is in the process of executing an effort in the spring of 2022 that will offer payment directly to qualifying pharmacies as well as other business entities that participate in this program to help Medicare recipients receive up to eight Covid-19 tests free each month.  

Currently, Medicare Advantage Plans sometimes cover and pay for over-the-counter (OTC) Covid-19 tests as a supplement in combination with providing Medicare Part A and Part B coverage. If you’re enrolled in a Medicare Advantage Plan, you should review the terms of the plan to check whether the plan will cover and pay for Covid-19 tests. 

All Medicare beneficiaries with Part B qualify to receive eight free OTC Covid-19 tests, despite whether a person is enrolled in a Medicare advantage plan.

The Center for Medicare Advocacy recently published a document answering various questions about Medicare’s home health benefits. In addition to a document answering frequently asked questions, the Center also published recordings of two webinars, “Medicare Coverage of Home Health Services”, which reviews the eligibility basics for Medicare coverage of home health services.

What Do Home Health Agencies Do?

Medicare’s home health benefits are known as the Mediacertified home health agencies. These benefits have been approved by Medicare to provide the home health services that Medicare covers. The agency has agreed to receive payment from Medicare. Additionally, Medicare only pays for home health services administered by home health agencies that are Medicare-certified. 

TWO SCHOOLS OF THOUGHT

It is never an easy decision to make decisions for another person when it is the other person who has to live with the consequences of those decisions. That is doubly true when there is not any family relation or close ties that bind you. When you are deciding for a family member, say for example an aged parent or grandparent, at least you have the benefit of years worth of conversations and their larger thoughts on certain key matters of health and health decisions. You can look back and remember what they did or said in certain similar scenarios. What about those who do not have any such close relatives who decide for them? There is a class of professional guardians across the state and country who are professional in every sense of the term. They examine an issue and consider the best way to get the answer by asking further questions of the experts, such as doctors, therapists, social workers and so on. The hardest decision that any guardian has to make, regardless of whether or not they had the benefit of ties of affinity, is whether or not to terminate treatment for an incompetent patient. By what yardstick do they measure their decisions?

If a patient already expressed their clear desire in the past as to what they want to do, the decision that the guardian must make will be much easier. The 1972 New Jersey case of In Re Quinlan sums up the decision making in this case best. In Quinlan, a young woman was in a vegetative state from which she was not likely going to recover. Her father applied to the Court to be her guardian so he could have the life supporting medical apparatus removed. The trial Court denied this application, although the state Supreme Court found a Constitutional right to privacy in such decisions to remove oneself from life support that the state cannot intervene in. Since she could do it personally, her guardian could do the same in her absence. The legal protections that control a guardian’s decisions ensure that guardians do not make their decisions with improper motive.

Elder care advocates are understandably up in arms following reports about questionable evictions from a Brooklyn facility catering to seniors. The sad situation is a reminder of the continuing struggles faced by so many local families in their quest for quality, reliable long-term care and support. It is also a troublesome sign that most communities remain drastically unprepared to provide the aid that will be needed in coming decades as the New York population ages.

NY Nursing Residents Evicted After Facility Closure

As reported by the NY Daily News last month, a group of over 100 Brooklyn seniors are currently scrambling to find alternative living arrangements following the announcement of the sudden closure of the Prospect Park Residence. The Park Slope facility has been a home for senior for over 15 years. But that will end in May, as the facility is slated to shut its door by the beginning of June.

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